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Implant Migration and Dislocation Following Lumbar Total Disc Replacement: A Scoping Review of Risk Factors,
Sumanth Kumar Gera1, Yiming Chen2, Gennie Lim3
1Department of Orthopaedics Surgery, National University Health System, Singapore, Singapore kg.sumanth@gmail.com.
Background:
Lumbar total disc replacement (TDR) is an alternative to interbody fusion for treating symptomatic degenerative disc disease. This approach involves replacing deteriorated lumbar discs with a prosthetic device to alleviate pain and maintain spinal mobility. This review maps the current findings on migration or dislocation related to TDR, identifies contributing factors, and summarizes reported treatment approaches and their results.
Methods:
A systematic search was conducted across MEDLINE, Embase, Scopus, Web of Science, and CENTRAL to identify relevant studies. The search identified 7 pertinent studies. The extracted data included study design, patient demographics, type of prosthesis used, direction of migration or dislocation, risk factors, and treatment methods.
Results:
The review of 7 articles on TDR indicated that significant migration or dislocation requiring surgical intervention was reported in approximately 1% to 2% of cases, typically within weeks to months after the procedure. A higher occurrence of clinically relevant subsidence was reported, which correlated with poorer patient outcomes. Anterior migrations predominated, while posterior and lateral migrations were rare. Risk factors observed included selecting an undersized or improperly positioned implant, surgical technique, and trauma. Treatment strategies ranged from conservative monitoring to revision arthroplasty for early malposition when the endplates were still intact and conversion to fusion.
Conclusions:
Clinically significant implant migration following lumbar TDR is rare but remains an important complication. Reported events most commonly occur early after surgery and are associated with heterogeneous factors, including implant sizing, surgical technique, and trauma. Management strategies vary, with conversion to fusion most frequently reported. The current literature remains limited by heterogeneous and inconsistently reported outcomes, highlighting the need for more standardized reporting of migration characteristics, risk factors, management strategies, and clinical outcomes in future studies.
Clinical Relevance:
Mapping the currently reported patterns, risk factors, and management strategies associated with implant migration following lumbar TDR may help inform surgical technique, postoperative surveillance, and future research reporting standards.
Level Of Evidence:
Not applicable; scoping review.
